Cardiovascular and thoracic retractor

ABSTRACT

A cardiovascular retractor is provided which is adapted to be mounted on a thoracic retractor. The cardiovascular retractor includes a clamp support which is mounted along an axis of a thoracic retractor and a retractor blade clamp adjustably secured to a rod of the clamp support. The clamp has a blade grip which grasps a retractor blade. The clamp also includes locking means. When the clamp locking means is not locked, the clamp is adjustable along the clamp support rod, the grip is rotatable in the clamp, the retractor blade is axially adjustably in the clamp, and the retractor blade is rotatable in the clamp. However, when the clamp locking means are locked the clamp locking means securely fix the retractor blade relative to the clamp support so that the retractor blade resists movement and will counteract the tension applied as the cardiovascular retractor is used.

BACKGROUND OF THE INVENTION

The invention relates to a cardiovascular and thoracic retractor, and inparticular, to a retractor used for open heart surgery. It aids theheart surgeon by letting the surgeon have more control over the surgicalprocedures; by presenting a retractor having a wide range ofadjustability to suit the individual morphology of patients; and byhelping to eliminate precious time in the use of the device.

The heart is a hollow muscular pump which lies in the chest cavity in aloose protective sack called the pericardium. The mass of the heart isan extremely powerful thick layer of muscle called the mycocardium.

The heart is divided internally to form four chambers. The upper andlower chambers are separated on the right side by the tricuspid valveand on the left side by the mitral valve. Additional valves are locatedat the outlets from the vessels which leave the heart.

When any of these valves become diseased and fail to operate properly,it may become necessary to perform open heart surgery for correction ofthe problem. It is possible, for example, to surgically implantartificial heart valves or homograft replacements to replace the naturalvalves.

During heart surgery, the chest is opened, commonly by an incisionseveral inches long along the axis of the sternum. A sternum retractoris used to maintain exposure of the heart. This retractor includes gripswhich fit on either side of the chest incision and are used first toopen the incision and then to maintain retraction of the ribs andmuscles of the chest.

Open heart surgery includes the further step of opening the thickmuscular layers of the heart to expose the diseased inner portion of theheart, for example the mitral valve. Commonly a surgical assistantretracts the myocardium or the vessels surrounding the heart usingretractor blades. Since the heart is an extremely powerful muscle, thepresent retraction technique presents the disadvantage that it requiresstrength and concentration on the part of the surgical assistant tomaintain the constant tension necessary to expose the diseased valve.Further disadvantages of this technique are that the heart surgeonrelinquishes control to the surgical assistant over this aspect of theoperation and that this technique requires an additional person to beinvolved in the operation.

A device is known from the prior art which mechanically performs the jobof the surgical assistant. This device utilizes retractor blades mountedon one grip of the sternal retractor to hold the myocardium open. Theretractor blades are mounted at a stationary position relative to thesternal retractor grip. The blades include holes along the handle whichlock on hooks on the grip. While several holes are provided along theblade handle and hooks are provided at various distances along the gripto give some flexibility in positioning the blades, the amount ofadjustment presented by the known device is limited. In fact, theadjustment is so limited that many surgeons might be deterred from useof the device.

An advantage of the present invention is the wide range of continuousadjustablilty, not only for the distances which the blades extend fromthe retractor grip and the placement along the grip, but also for theangle, tilt, and rotation for the retractor blades. This feature isimportant to allow for the many morphological variations in individuals.Many of these differences cannot be anticipated until the surgeon hasopened the chest or heart. The surgeon may even decide to vary theposition of the retractors during surgery.

A further advantage of the present invention is that while it allows agreat deal of adjustability, it is designed to allow the user to go fromfull adjustability to a locked position very easily.

Another advantage of the present invention is that it is designed forquick and easy assembly and disassembly.

The adjustability and the ease of use of this retractor add to theultimate goal of any surgeon, and in particular of a heart surgeon; thedevice helps to simplify a complex operation by eliminating the need fora surgical assistant and allowing the heart surgeon more control andflexibility in performing the operation. Further the device is designedto allow infinite adjustability while decreasing time needed to preparefor open heart surgery and to finish the operation.

SUMMARY OF THE INVENTION

In accordance with the invention, a cardiovascular retractor bladesupport is supported along an axis of a grip of a thoracic retractor,such as a Cooley sternum retractor. The retractor includes two parallelspaced grips which engage either side of the chest incision and whichare mounted at one end perpendicular to a toothed crossbar. A pinion ismounted on one of the grips and engages the teeth of the crossbar foradjustment of the space between the grips.

The retractor blade support includes a rod which extends parallel to thegrip between two brackets. The rod supports one or more retractor bladeclamps which holds a retractor blade. The clamp permits continuousadjustment of the retractor blade. The retractor blade can be axiallyextended in relation to the clamp. Further, the blade can be rotated,and the angle of the central axis of the blade with respect to the axisof the rod can be varied.

The clamp is designed to allow flexibility in positioning the retractorblade, but to come to a quick locked position, and also to hold theretractor blade in a locked position with sufficient force to resist thepull of the powerful heart muscle. The retractor blade support isdesigned to allow for quick and easy assembly and disassembly.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a perspective view of the cardiovascular and thoracicretractor in accordance with the invention;

FIG. 2 shows an end view of the first retractor blade support bracketwith portions broken away;

FIG. 3 shows an end view of the second retractor blade support bracket;

FIG. 4 shows a vertical cross-section of the retractor blade clamp;

FIG. 5 shows an end view of a retractor blade support bracket of thesecond embodiment of the invention;

FIG. 6 shows a front view of the retractor blade support bracket of thesecond embodiment taken along line 6--6; PG,4

FIG. 7 shows a perspective view of a portion of the retractor inaccordance with a third embodiment of the invention;

FIG. 8 shows an end view of the first retractor blade support bracket ofthe third embodiment of the invention; and

FIG. 9 shows an end view of the second retractor blade support bracketfor the third embodiment with portions broken away.

DETAILED DESCRIPTION OF THE DRAWINGS

The invention concerns a cardiovascular and thoracic retractor 5comprising a thoracic retractor 10 and a cardiovascular retractor 12mounted on the thoracic retractor 10. The cardiovascular retractor 12 ofthe present invention is illustrated with a Cooley sternum retractor;however it should be understood that other sternum retractors could beused. The thoracic retractor 10 includes a first grip 15 and a secondgrip 17 having a first cuff 19 and a second cuff 21, respectively. Thecuffs 19, 21 engage either side of the chest incision to expose theinternal organs during the operation. The grips 15, 17 are mounted in aspaced parallel position to each other by means of a toothed crossbar 23which extends perpendicularly between a distal portion 25, 27 of thefirst and second grips 15, 17. A flat arm portion 30, 32 extends betweenthe distal portion and the cuff of each grip. The first grip 15 is fixedrelative to the crossbar 23.

The second grip 17 includes on its distal end 27 a pinion. The pinionhas a pivot 37 which extends through a slot (not shown) in the distalportion 27 of the grip 17. The pivot 37 is attached to a disc (notshown), the disc having two extending pins (not shown) spaced at aproper distance for engagement of the teeth 47 on the toothed crossbar23. The pivot 37 has at the opposing end a handle 50 which is pivotallymounted on a pin (not shown) extending through the pivot 37 so that thepivot 37 can be rotated by the handle 50.

As the handle 50 is rotated, the extending pins engage the teeth 47 ofthe crossbar 23 forming a rack and pinion system, whereby the distancebetween the grips 15, 17 can be increased. When the pivot 37 is in theproper position the retractor is locked to resist the forces which wouldtend to close the incision.

The cardiovascular retractor 12 includes a clamp support 56 adapted tobe mounted on the thoracic retractor 10 along the axis of the first grip15. The cardiovascular retractor 12 further comprises one or moreretractor blade clamps 53 secured to the clamp support 56. The retractorblade clamp 53 engages a retractor blade 51.

The retractor blade support 56 includes a first and second bracket 58,60. Both brackets include a groove 62 at the lower end. A sleeve 65 ishoused in the groove 62 and extends between the brackets 58, 60 to holdthe brackets in a spaced parallel position. The sleeve 65 providesrigidity for the rod 55 which extends between the upper ends of thebrackets 58, 60.

The sleeve 65 forms a female member which mates with a male memberprotruding from the thoracic retractor 10. In this case the male memberis a bar 68 which is joined to the upper side of the first grip 15, asfor example by weld 70. Of course, the clamp support 56 could includethe male member and the thoracic support 10 could include the femalemember.

A threaded pin 74 having a knob 76 engages a threaded opening 78 in thefirst support 58. The pin 74 extends through a hole 77 in the sleeve 65to bear against the bar 68 when the pin 74 is rotated to its lockedposition. This allows the retractor blade support 56 to be secured tothe bar 68 on the thoracic retractor 10.

The rod 55 has at one end threads 79 and a grip 80 at the other end. Therod 55 is fed through a hole 82 in the first bracket 58 (and through abore 93 in the clamp 53) until the threads 78 of the rod 55 engage athreaded opening 84 in the second bracket 60 as can be seen in FIG. 3.The rod 55 is screwed in position by turning the grip 80.

The retractor blade 51 consists of an elongate handle 86 and a flatcurve 88 for retention of the vessels or organ. The handle 86 is held inposition relative to the retractor blade support 56 by means of theclamp 53 which grasps the handle 86 about the central axis of theretractor blade 51. One retractor blade may be mounted on the retractorblade support; however, more commonly, two or more retractor blades willbe secured to the retractor blade support, each blade 51 being held byits own clamp 53. The clamp 53 is mounted on the rod 55 and ispositionable along the axis of the rod 55.

The clamp 53 is constructed to allow a great deal of adjustability inthe position of the retractor blade 51. When the clamp 53 is not locked,the clamp 53 can be slid along the axis of the rod 55. Further, theclamp 53 may be rotated about the axis of the bar 55 to vary the angleof the blade 51 and more specifically of the angle between the planeextending through the axis of the blade 51 and tangential to the flatcurve 88 and the plane extending through the axis of the rod 55. Theblade 50 is held in a blade grip 106 which is rotatable about its axisin the clamp 53 to vary the angle formed between the axis of the blade50 and the axis of the rod 55. It is possible as well to slide thehandle portion 86 of the blade in or out of the clamp 53 so that thecurve portion 88 may be axially extended or retracted. Further, theretractor blade 51 may be rotated about its central axis to vary thetilt of the curve portion 88 of the retractor blade 51.

The clamp 53 is designed to allow a great deal of adjustability as hasbeen explained, but to come into a locked position, eliminating alladjustment by a relatively slight change in the clamp. The position ofthe retractor blade 51 becomes fixed when the knob 90 is rotated tocause the clamp to lock.

A detailed drawing of the clamp 53 is shown in FIG. 4. The clamp 53includes a collar 92 having a bore 93 which engages the rod 55. A slot95 extends through a flange portion 96 of the collar 92 to the bore 93.A second bore 98 extends through the flange portion 96 of the collar 92,axially transverse to the slot 95 and spaced apart from the first bore93. The second bore 98 ends in a conical indentation 100 which mateswith the conical portion 102 of a sleeve 104. The sleeve 104 has aconcentric hollow portion 105.

A blade grip 106 having a pin portion 108 and a vice portion 110 extendsthrough the second bore 98 and the sleeve 104. The grip 106 has acentral axis which is aligned with the axis of the bore 98 and thesleeve 104. The grip 106 and the vice portion 110 includes an opening112 which extends through the grip 106. The axis of the opening 112 istransverse to the axis of the rod 55. The sleeve 104 also includesopenings 114 and 115 substantially aligned with the opening 112 so thatthe handle 86 of the retractor blade 51 extends through the openings 112and 114, and 115 respectively of the blade grip 106 and sleeve 104. Theknob 90 includes a threaded hole 118 which engages the threads on thepin portion 108 of the grip 106. The knob 90 further is hollow to form arecess 120 which houses a spring 122. The spring 122 biases the knoboutward by cooperating with a spacer 119 which rests against the top ofthe collar 92.

The rotation of the knob 90 which engages the threads in the pin portion108 of the grip 106 causes the blade grip 106 to be raised in the collar92. This forces the sleeve 104 against the collar 92 as the shoulder 109of the grip 106 engages a corresponding shoulder 107 of the sleeve 104.The retractor blade 51 is locked from rotational movement about the axisof the grip 106 as the conical portion 102 of the sleeve 104 engages theconical indentation 100 of the collar 92. This has the further effect oflocking the collar 92 from rotational or axial movement relative to therod 55 by closing the slot 95 and causing the first bore 93 to tightenaround the surface of the rod 55.

The position of the retractor blade 51 is locked radially along its ownaxis, and further from rotation about its central axis by the viceportion 110 and the sleeve 104. As the blade grip 106 is raised inrelation to the sleeve 104, the handle 86 of the retractor blade 51 islocked on the bottom side by the bore 112 of the vice 110, and on thetop side by the openings 114, 115 of the sleeve 104. This locks theretractor blade 51 against axial movement and rotation.

The spring 122 biases the grip 106 upward relative to the collar 92 andeliminates play in the mechanism of the clamp 53. The clamp 53 isdesigned so that the turning of the knob 90 causes all the possibleadjustments to be locked.

FIGS. 5 and 6 show a second embodiment of the invention, wherein thefirst and second supports 160 include a recess 123 having a shapedesigned for snug engagement of the rod 155 but also designed so thatthe rod 155 may be easily disengaged from the retractor blade support bysimply pulling the rod 155 up out of the recess 123. Likewise, the rod155 can simply be dropped into the recess 123. The supports 160 alsoinclude guards 125 for the lateral positioning of the rod 155 in therecess 123.

Use of the device is envisioned as follows: prior to surgery thecardiovascular retractor 12 is assembled. The rod 55 is threaded throughthe hole 82 in the first support 58, through the bore 93 in the clamp53, and engages the threaded opening 84 in the second support 60. Thegrip 80 of the rod 55 is turned to lock the rod 55 into position.

During surgery, the thoracic cavity will be opened as usual using thethoracic retractor 10. The cardiovascular retractor 12 is subsequentlymounted on the thoracic retractor 10 by positioning the sleeve 65 of theretractor blade mount 56 on the bar 68 on the grip 15 of the thoracicretractor 10. The retractor blade mount 56 is locked on the bar 68 byturning the knob 76.

The user slides the clamp 53 into the proper position along the axis ofthe rod 55 and positions the retractor blade 51 as desired, moving theblade into the proper position for surgery. The knob 90 is tightened andthe blade 51 is subsequently held in the desired position. Thisembodiment is designed so that the rod 55 cannot inadvertently bedislocated from the brackets 58, 60.

When surgery has been completed, the knobs 90 and 76 are loosened, theretractor blade 51 is disengaged, and the retractor blade support 56 canbe lifted from the bar 68.

The embodiment shown in FIGS. 5 and 6 is used in a similar manner,except that the rod 155 is not threaded through openings in the firstand second brackets prior to surgery, but rather engaged in the recess123 in the first and second brackets 160 after the blade support 156 ismounted on the grip 15. This embodiment is designed so that the rod 155is easily disengaged from the brackets.

Another embodiment of the invention is shown in FIGS. 7, 8 and 9. Thisembodiment is also used in a manner similar to that described, exceptthat the rod 255 engages a slot 253 in the first bracket 258 and ispivotably joined at the other end in a slot 257 in the bracket 260 as bythe in 254. The end of the rod 255 which engages the slot 253 in thefirst bracket 260 includes a threaded portion 262 which cooperates witha knob 290. The knob 290 is threaded onto the rod 255 after the clamps53 have been slide onto the rod 255. The knob 290 includes a sleeveportion 291 which engages a counterbore 270 portion of the slot 253. Asthe knob 290 is tightened on the rod 255 the sleeve portion 291 gripsthe counterbore 270 and locks the rod 255 into position between thebrackets 258, 260.

Although the preferred embodiment of this invention has been shown anddescribed, it should be understood that various and modifications andrearrangements of the parts may be resorted to without departing fromthe scope of the invention as disclosed and claimed herein.

What is claimed is:
 1. A cardiovascular retractor .[.comprising.]..Iadd.adapted for connection to .Iaddend.a thoracic sternum retractorincluding a pair of arms and a crossbar interconnecting said arms, .[.asecond.]. .Iadd.the cardiovascular .Iaddend.retractor comprising.Iadd.:.Iaddend.a rod having opposite ends.[.,.]. .Iadd.; .Iaddend. a pair ofbrackets each secured to the opposite ends of said rod.[.,.]. .Iadd.;.Iaddend. connecting means extending between and attached to saidbrackets parallel to and spaced from said rod.[.,.]..Iadd.; .Iaddend.means .[.mounting.]. .Iadd.adapted to mount .Iaddend.said .[.second.]..Iadd.cardiovascular .Iaddend.retractor on one of said arms with saidrod generally parallel to the arm.[.,.]. .Iadd.; .Iaddend. a blade clampmounted on said rod between said brackets and constructed and arrangedto be movable along said rod.[.,.]. .Iadd.; .Iaddend. a retractor bladehaving a handle and mounted on said blade clamp to permit movement ofsaid handle along its axis with respect to said clamp.[.,.]. .Iadd.;.Iaddend.and gripping means constructed and arranged to fixedly positionsaid blade handle with respect to said clamp and said clamp with respectto said rod.
 2. A cardiovascular retractor as set forth in claim 1,wherein said .[.second.]. .Iadd.cardiovascular .Iaddend.retractor is.Iadd.adapted to be .Iaddend.removably mounted on said one arm.
 3. Acardiovascular retractor as set forth in claim 2, wherein saidconnecting means is a sleeve and said .[.removable mounting.]. means.Iadd.adapted to mount said cardiovascular retractor on one of said arms.Iaddend.comprises said sleeve and a bar secured to said one arm andreceived in said sleeve to permit movement of said .[.second.]..Iadd.cardiovascular .Iaddend.retractor along the axis of said bar.
 4. Acardiovascular retractor as set forth in claim 3, including means toclamp said sleeve to said bar to prevent axial movement.
 5. Acardiovascular retractor as set forth in claim 1, wherein said rod isremovably attached to at least one of said brackets.
 6. A cardiovascularretractor as set forth in claim 5, wherein said releasable attachmentcomprises aligned bores in both of said brackets to receive said rod,one of said bores having internal threads and the adjacent rod endhaving external threads in engagement with said internal threads.
 7. Acardiovascular retractor as set forth in claim 5, wherein saidreleasable attachment comprises a recess on each of said bracketsarranged to snugly receive said bar, and guard means to prevent movementof said rod along its axis with respect to said brackets.
 8. Acardiovascular retractor as set forth in claim 5, wherein said rod ispivotally connected at one end to one bracket for rotation about an axisperpendicular to the axis of the rod, and clamp means on the other endof said rod engageable with the other bracket. .Iadd.
 9. Acardiovascular retractor of the type adapted to be connected to athoracic retractor, the thoracic retractor including first and secondgrips defining longitudinal axes that are disposed generally parallel toeach other, the first and second grips including means for engagingfirst portions of a patient's body, the first and second grips beingconnected to each other by a crossbar such that they can be displacedaway from each other in order to pull the first portions apart, thecardiovascular retractor comprising:an elongate rod disposed adjacent aselected one of the first or second grips; connector means adapted toconnect the rod to the selected grip and not to the crossbar and tomaintain the rod in a fixed position relative to the grip; a retractorblade having a portion adapted to engage a second portion of thepatient's body, the retractor blade having a longitudinally extendinghandle; means for connecting the handle of the retractor blade to therod, the means for connecting permitting the blade to be adjustedrelative to a second portion of the patient's body; and means forlocking the blade in a fixed position relative to the rod. .Iaddend..Iadd.
 10. The cardiovascular retractor of claim 9, wherein the rod isspaced from the grip to which it is connected. .Iaddend. .Iadd.11. Thecardiovascular retractor of claim 9, wherein the rod is disposedgenerally parallel to the longitudinal axis of the grip to which it isconnected. .Iaddend. .Iadd.12. The cardiovascular retractor of claim 9,wherein the connector means establishes a releasable connection betweenthe rod and the grip. .Iaddend. .Iadd.13. The cardiovascular retractorof claim 12, wherein the releasable connection includes a bar secured tothe grip, a sleeve disposed about the bar, and a threaded pin thatextends through the sleeve into contact with the bar. .Iaddend..Iadd.14. The cardiovascular retractor of claim 9, wherein the connectormeans is in the form of spaced brackets connected to the grip, thebrackets being secured to the opposite ends of the rod. .Iaddend..Iadd.15. The cardiovascular retractor of claim 9, wherein the means forconnecting the handle of the retractor blade to the rod is in the formof a clamp having a movable portion disposed about the rod. .Iaddend..Iadd.16. The cardiovascular retractor of claim 9, wherein the means forlocking the blade in a fixed position relative to the rod is in the formof a clamp having a movable portion disposed about the handle. .Iaddend..Iadd.17. The cardiovascular retractor of claim 9, wherein the means forconnecting the handle of the retractor blade to the rod and the meansfor locking the blade in a fixed position relative to the rod is in theform of a clamp having a first movable portion disposed about the rodand a second movable portion disposed about the handle. .Iaddend..Iadd.18. The cardiovascular retractor of claim 17 wherein the clampfurther includes a threaded pin connected to the first and secondmovable portions, the pin upon tightening causing the first and secondmovable portions to be moved toward each other so as to securely engagethe rod and the handle, respectively, and prevent relative movementtherebetween. .Iaddend. .Iadd.19. Apparatus for cardiovascularretraction, comprising:a thoracic retractor, including: first and secondgrips defining longitudinal axes that are disposed generally parallel toeach other, the first and second grips including means for engagingfirst portions of a patient's body, the first and second grips beingconnected to each other by a crossbar such that they can be displacedaway from each other in order to pull the first portions apart; and acardiovascular retractor, including:an elongate rod disposed adjacent aselected one of the first or second grips; means for connecting the rodto the selected grip and not to the crossbar and for maintaining the rodin a fixed position relative to the grip; a retractor blade having aportion adapted to engage a second portion of the patient's body, theretractor blade having a longitudinally extending handle; means forconnecting the handle of the retractor blade to the rod, the means forconnecting permitting the blade to be adjusted relative to a secondportion of the patient's body; and means for locking the blade in afixed position relative to the rod. .Iaddend. .Iadd.20. The apparatus ofclaim 19, wherein the rod is spaced from the grip to which it isconnected. .Iaddend. .Iadd.21. The apparatus of claim 19, wherein therod is disposed generally parallel to the longitudinal axis of the gripto which it is connected. .Iaddend. .Iadd.22. The apparatus of claim 19,wherein the means for connecting the rod to the grip establishes areleasable connection between the rod and the grip. .Iaddend. .Iadd.23.The apparatus of claim 22, wherein the releasable connection includes abar secured to the grip, a sleeve disposed about the bar, and a threadedpin that extends through the sleeve into contact with the bar. .Iaddend..Iadd.24. The apparatus of claim 19, wherein the means for connectingthe rod to the grip is in the form of spaced brackets connected to thegrip, the brackets being secured to the opposite ends of the rod..Iaddend. .Iadd.25. The apparatus of claim 19, wherein the means forconnecting the handle of the retractor blade to the rod is in the formof a clamp having a movable portion disposed about the rod. .Iaddend..Iadd.26. The apparatus of claim 19, wherein the means for locking theblade in a fixed position relative to the rod is in the form of a clamphaving a movable portion disposed about the handle. .Iaddend. .Iadd.27.The apparatus of claim 19, wherein the means for connecting the handleof the retractor blade to the rod and the means for locking the blade ina fixed position relative to the rod is in the form of a clamp having afirst movable portion disposed about the rod and a second movableportion disposed about the handle. .Iaddend. .Iadd.28. The apparatus ofclaim 27, wherein the clamp further includes a threaded pin connected tothe first and second movable portions, the pin upon tightening causingthe first and second movable portions to be moved toward each other soas to securely engage the rod and the handle, respectively, and preventrelative movement therebetween. .Iaddend. .Iadd.29. A method forperforming cardiovascular retraction where a patient's chest cavity hasbeen opened by a thoracic retractor, comprising the steps of:providingan elongate rod; connecting the elongate rod to the thoracic retractor;maintaining the rod in a fixed position relative to the retractor;providing a retractor blade having a portion adapted to engage aselected portion of the patient's body within the chest cavity, theretractor blade having a longitudinally extending handle; connecting theretractor blade to the rod; engaging the retractor blade with theselected portion of the patient's body; pulling the retractor blade todisplace the selected portion of the patient's body; and locking theretractor blade in a fixed position relative to the rod. .Iaddend..Iadd.30. The method of claim 29, wherein the thoracic retractor has agrip defining a longitudinal axis, and comprising the further steps ofdisposing the rod in spaced relationship to the grip and aligning therod generally parallel with the longitudinal axis of the grip. .Iaddend..Iadd.31. A method for performing cardiovascular retraction, comprisingthe steps of: providing a thoracic retractor, the thoracic retractorincluding first and second grips that define longitudinal axes that aredisposed generally parallel to each other, the first and second gripsincluding means for engaging first portions of a patient's body;engaging the grips with the first portions of the patient's body;displacing the grips away from each other in order to pull the firstportions of the patient's body apart; providing an elongate rod;connecting the rod to a selected one of the grips; maintaining the rodin a fixed position relative to the grip; providing a retractor bladehaving a portion adapted to engage a second portion of the patient'sbody, the retractor blade having a longitudinally extending handle;connecting the retractor blade to the rod; engaging the retractor bladewith the second portion of the patient's body; pulling the retractorblade to displace the second portion of the patient's body; and lockingthe retractor blade in a fixed position relative to the rod. .Iaddend..Iadd.32. The method of claim 31, comprising the further steps ofdisposing the rod in spaced relationship to the grip and aligning therod generally parallel with the longitudinal axis of the grip. .Iaddend..Iadd.33. A cardiovascular retractor of the type adapted to be connectedto a thoracic reactor, the thoracic retractor including first and secondgrips defining longitudinal axes that are disposed generally parallel toeach other, the first and second grips including means for engagingfirst portions of a patient's body, the first and second grips beingconnected to each other such that they can be displaced away from eachother in order to pull the first portions apart, the cardiovascularretractor comprising:an elongate rod disposed adjacent a selected one ofthe first or second grips, the rod being disposed generally parallel tothe longitudinal axis of the grip to which it is connected; connectormeans adapted to connect the rod to the selected grip and to maintainthe rod in a fixed position relative to the grip; a retractor bladehaving a portion adapted to engage a second portion of the patient'sbody, the retractor blade having a longitudinally extending handle;means for connecting the handle of the retractor blade to the rod, themeans for connecting permitting the blade to be adjusted relative to asecond portion of the patient's body; and means for locking the blade ina fixed position relative to the rod. .Iaddend. .Iadd.34. Thecardiovascular retractor of claim 33, wherein the connector meansestablishes a releasable connection between the rod and the grip, thereleasable connection including a bar secured to the grip, a sleevedisposed about the bar, and a threaded pin that extends through thesleeve into contact with the bar. .Iaddend. .Iadd.35. The cardiovascularretractor of claim 33, wherein the connector means is in the form ofspaced brackets connected to the grip, the brackets being secured toopposite ends of the rod. .Iaddend. .Iadd.36. Apparatus forcardiovascular retraction, comprising:a thoracic retractor,including:first and second grips defining longitudinal axes that aredisposed generally parallel to each other, the first and second gripsincluding means for engaging first portions of a patient's body, thefirst and second grips being connected to each other such that they canbe displaced away from each other in order to pull the first portionsapart; and a cardiovascular retractor, including:an elongate roddisposed adjacent a selected one of the first or second grips, the rodbeing disposed generally parallel to the longitudinal axis of the gripto which it is connected; means for connecting the rod to the selectedgrip and for maintaining the rod in a fixed position relative to thegrip; a retractor blade having a portion adapted to engage a secondportion of the patient's body, the retractor blade having alongitudinally extending handle; means for connecting the handle of theretractor blade to the rod, the means for connecting permitting theblade to be adjusted relative to a second portion of the patient's body;and means for locking the blade in a fixed position relative to the rod..Iaddend. .Iadd.37. The apparatus of claim 36, wherein the means forconnecting the rod to the grip establishes a releasable connectionbetween the rod and the grip, the releasable connection including a barsecured to the grip, a sleeve disposed about the bar, and a threaded pinthat extends through the sleeve into contact with the bar. .Iaddend..Iadd.38. The apparatus of claim 36, wherein the means for connectingthe rod to the grip is in the form of spaced brackets connected to thegrip, the brackets being secured to opposite ends of the rod. .Iaddend.